Justa Friebus-Kardash, Amina Louzi, Andreas Kribben, Hartmut H. Schmidt, Michael Jahn, Bartosz Tyczynski, Jassin Rashidi-Alavijeh, Andreas Schütte, Amos Zeller
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Albumin dialysis is a therapeutic option that can be used to bridge patients with ACLF to liver transplantation or recovery.</p>\n </section>\n \n <section>\n \n <h3> Methods</h3>\n \n <p>This retrospective cohort study was conducted to determine the effectiveness and adverse effects of open albumin dialysis (OPAL) by comparing the biochemical and clinical variables of model for end-stage liver disease (MELD)-matched ACLF patients who received one of three treatments: OPAL plus standard medical treatment (SMT; 22 patients), Prometheus dialysis fractionated plasma separation and adsorption (FPSA) plus SMT (41 patients), or hemodialysis plus SMT (24 patients) at the University Hospital Essen.</p>\n </section>\n \n <section>\n \n <h3> Results</h3>\n \n <p>OPAL treatment significantly reduced liver function tests such as bilirubin (<i>p</i> = 0.0001) and creatinine levels (<i>p</i> = 0.049). Therefore, OPAL therapy significantly reduced the MELD score (<i>p</i> = 0.001) and the Chronic Liver Failure Consortium (CLIF-C) ACLF (<i>p</i> = 0.0005) score. In both extracorporeal liver support groups, the decrease in MELD score was significantly stronger than that achieved with SMT (OPAL vs. SMT, <i>p</i> = 0.002; Prometheus vs. SMT, <i>p</i> = 0.0001; OPAL vs. Prometheus <i>p</i> = 0.90). In comparison to the SMT group, survival rates after 14 and 30 days were significantly higher in the Prometheus group (<i>p</i> = 0.0008 and 0.03) and tended to be better in the OPAL group, although statistical significance was not reached (<i>p</i> = 0.06 and <i>p</i> = 0.11).</p>\n </section>\n \n <section>\n \n <h3> Conclusions</h3>\n \n <p>Our analysis revealed OPAL is an efficient method of albumin dialysis yielding a reduction of bilirubin and creatinine levels and improving clinical scoring in ACLF patients. OPAL as well as Prometheus were associated with a stronger reduction of relevant biochemical variables of liver function and amelioration in clinical scoring in comparison to SMT. However, it should be considered that patients from the SMT group were older and experienced progressive ACLF with high mortality risks compared to the patients from the OPAL and Prometheus groups. Thus, when interpreting the study results, several limitations including small sample size and heterogeneity of the treatment groups due to the lack of randomization should be taken into account.</p>\n </section>\n </div>","PeriodicalId":8450,"journal":{"name":"Artificial organs","volume":"49 6","pages":"997-1011"},"PeriodicalIF":2.2000,"publicationDate":"2025-02-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/aor.14977","citationCount":"0","resultStr":"{\"title\":\"Comparison of Open Albumin Dialysis (OPAL) With Prometheus Fractionated Plasma Separation and Adsorption (FPSA) and Standard Medical Treatment for Acute-On-Chronic Liver Failure\",\"authors\":\"Justa Friebus-Kardash, Amina Louzi, Andreas Kribben, Hartmut H. 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引用次数: 0
摘要
背景：急性慢性肝衰竭（ACLF）与高达40%的高短期死亡率相关。白蛋白透析是一种治疗选择，可用于ACLF患者肝移植或恢复的桥梁。方法：本回顾性队列研究通过比较接受开放式白蛋白透析（OPAL）加标准药物治疗（SMT）三种治疗方法之一的终末期肝病（MELD）模型匹配ACLF患者的生化和临床变量，来确定开放式白蛋白透析（OPAL）的有效性和不良反应；22例患者)，Prometheus透析分离式血浆分离和吸附（FPSA）加SMT（41例患者），或血液透析加SMT（24例患者）在埃森大学医院。结果：OPAL治疗显著降低肝功能测试，如胆红素（p = 0.0001）和肌酐水平（p = 0.049）。因此，OPAL治疗显著降低MELD评分（p = 0.001）和慢性肝衰竭联盟（c克里夫- c） ACLF评分（p = 0.0005）。在两个体外肝支持组中，MELD评分的下降明显强于SMT组(OPAL vs. SMT, p = 0.002；普罗米修斯vs. SMT, p = 0.0001；OPAL vs. Prometheus p = 0.90)。与SMT组相比，Prometheus组14天和30天后的生存率显著高于SMT组（p = 0.0008和0.03），OPAL组有更好的趋势，但未达到统计学意义（p = 0.06和p = 0.11）。结论：我们的分析显示OPAL是一种有效的白蛋白透析方法，可降低ACLF患者的胆红素和肌酐水平，提高临床评分。与SMT相比，OPAL和Prometheus与肝功能相关生化变量的降低和临床评分的改善有更强的相关性。然而，与OPAL组和普罗米修斯组相比，SMT组患者年龄较大，经历进行性ACLF，死亡风险高。因此，在解释研究结果时，应考虑到一些局限性，包括小样本量和由于缺乏随机化而导致的治疗组的异质性。
Comparison of Open Albumin Dialysis (OPAL) With Prometheus Fractionated Plasma Separation and Adsorption (FPSA) and Standard Medical Treatment for Acute-On-Chronic Liver Failure
Background
Acute-on-chronic liver failure (ACLF) is associated with high short-term mortality of up to 40%. Albumin dialysis is a therapeutic option that can be used to bridge patients with ACLF to liver transplantation or recovery.
Methods
This retrospective cohort study was conducted to determine the effectiveness and adverse effects of open albumin dialysis (OPAL) by comparing the biochemical and clinical variables of model for end-stage liver disease (MELD)-matched ACLF patients who received one of three treatments: OPAL plus standard medical treatment (SMT; 22 patients), Prometheus dialysis fractionated plasma separation and adsorption (FPSA) plus SMT (41 patients), or hemodialysis plus SMT (24 patients) at the University Hospital Essen.
Results
OPAL treatment significantly reduced liver function tests such as bilirubin (p = 0.0001) and creatinine levels (p = 0.049). Therefore, OPAL therapy significantly reduced the MELD score (p = 0.001) and the Chronic Liver Failure Consortium (CLIF-C) ACLF (p = 0.0005) score. In both extracorporeal liver support groups, the decrease in MELD score was significantly stronger than that achieved with SMT (OPAL vs. SMT, p = 0.002; Prometheus vs. SMT, p = 0.0001; OPAL vs. Prometheus p = 0.90). In comparison to the SMT group, survival rates after 14 and 30 days were significantly higher in the Prometheus group (p = 0.0008 and 0.03) and tended to be better in the OPAL group, although statistical significance was not reached (p = 0.06 and p = 0.11).
Conclusions
Our analysis revealed OPAL is an efficient method of albumin dialysis yielding a reduction of bilirubin and creatinine levels and improving clinical scoring in ACLF patients. OPAL as well as Prometheus were associated with a stronger reduction of relevant biochemical variables of liver function and amelioration in clinical scoring in comparison to SMT. However, it should be considered that patients from the SMT group were older and experienced progressive ACLF with high mortality risks compared to the patients from the OPAL and Prometheus groups. Thus, when interpreting the study results, several limitations including small sample size and heterogeneity of the treatment groups due to the lack of randomization should be taken into account.
期刊介绍：
Artificial Organs is the official peer reviewed journal of The International Federation for Artificial Organs (Members of the Federation are: The American Society for Artificial Internal Organs, The European Society for Artificial Organs, and The Japanese Society for Artificial Organs), The International Faculty for Artificial Organs, the International Society for Rotary Blood Pumps, The International Society for Pediatric Mechanical Cardiopulmonary Support, and the Vienna International Workshop on Functional Electrical Stimulation. Artificial Organs publishes original research articles dealing with developments in artificial organs applications and treatment modalities and their clinical applications worldwide. Membership in the Societies listed above is not a prerequisite for publication. Articles are published without charge to the author except for color figures and excess page charges as noted.
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